Plasmapheresis in sepsis.

Despite the impressive advances in our understanding of the basic mechanism of sepsis, mortality associated with sepsis remains high. Some experimental and clinical evidence suggests that hemofiltration or other technics commonly used in the continuous renal replacement therapies are able to remove sepsis mediators, although the precise mechanism responsible (filtration or adsorbtion) can differ according to membrane used. It has not yet been convincingly demonstrated, however, that these effects can influence the outcome. In recent years plasma processing technics such us plasma exchange and plasmapheresis have been increasingly used with the aim of removing septic mediators. Albeit slightly more complicated than the commonly used continuous renal replacement therapies techniques, these procedures allow the removal of substances with higher molecular weight, and, with the more sophisticated devices, the plasma processed can be reinfused instead of discarded, thus reducting the need for replacement fluid. Even if these treatments had been associated with an overall improvement of sepsis-induced pathophysiologic derangements, more experience is needed to establish their effect of the outcome of septic patients.